14-0000

104-10117-10076

| 2025 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992 |

sone ¢ ee

PERSONAL HISTORY STATEMENT — (Appendix I)

Listed below are names of organizations identified by the Attorney General, under his responsibility pursuant to
Executive Order 10450, dated. 27 April 1953, to st the names of. each foreign or domestic. arganization, association,
movement, group or combination.of persons which he designates as Totalitarian, Fascist, Communist, or subversive,
or:as baying adopted. or having shown a policy of advocating or: approving the:commission. of acts af force or vio-
lence to deny others their rights under. the Constitution of the United: States, or as seeking to alter the form. of
government. of the United States by unconstitutional means.

Fach applicant or employee.and spouse (if any). must. review the following list of organizations for certification
purposes,.and sign: on: the: last page.

: Boston. School for Marxist. Studies,.Bostan, Massachusetts

yarn revere art cn ; no one oe
Actlan. Committee to Free-Spain Now Bulgarian American: People's. League of the United States of
Alabama. People's. Btucattonal. Association (see Communist Politi- America

= wate tor tm Yugoslavia, Inc.
American Association. Reconstruction : - Callfornt Det Committee
Americam Branch. of: the Federation: of Greek Maritime Unions : brary . me, 381 Divisadero Btreet,.gan
American Christian: Nationalist. California Labar School,.Inc.. Pranciaco,

Party
American. Committee for Buropean: Workers: Relief (sce Socialist

American Comunittes: for Yugosiav: Retief; Inc:
to: G@unreyx Labor Conditions:in Europe .
: . ‘known sa the: |

‘ Citizens Committes: af the Upper West Side (New York City)

! Citisens Committes to Free Karl Browder

Citizens: Protective Leagus

Civil: Laberties Sponsoring Committes of Pitteburgh

‘Civil Rights Congress and. its affiliated organisations, including:
Civil Rights. Congress for Texas
Veterans Agsinst. Discrimination. of Givil’ Rights Cangrres of

New York

Civil Rights Gongress. for Texas (see Civil Rights Congress)

Columbians

Comite Coorlinador Pro: Republica Espanola

(Sea: Puerto Rican Comite Pro Libertades Civiles)
Committes-for'a Democratic Par Eastern Policy

American. Russian. Institute; New York, also:known as the Ameri- |’ Committees for Constitutianal and. Polities!. Preedom
can Russian Institute for. Cultural Relations with the Soviet | Committee for: Nationalist. Action -

Cammittee for Peace and Brotherhood Festival in Philadelphia

American Russian Instituts,. Philadelphia . Committees forthe Defenss of the Pittsburgh. Bix

Axsoerican Russian Institute of. San: Francisco Committes-for-the Negm-in the Arts
American: Russian: Institute of Gouthern California, Los Angeles Committee for the-Protection of the Bill of Rights
American Slav. Congress Committee. for. World Youth: Friendship and Cultural Exchange
American Women for Peace Committee to Aboliah Discrimination in Maryland
American. Youth. Congress (Bee. Congress Against. Discrimination; Maryland Congress
American Youth for Democracy Against Discrimination; Provisional Committee to Abolish
Armenian Progressive League of Americs Discrimination in the State of Maryland)
Ansociated Klans of Amertca Committee to: Aid the Pighting- Bouth
Association of Georgia: Klans Committes. to Defend Marie Bichardson
Association of. German Netionals (Reichsdeuteche Vereinigung) Committees to Defend the Rights and Preedom of Pittsburgh's
Aucland-Organiration Ger NSDAP; Overseas Branch of Nari Party ;  Polltical Prisoners:
OComanitres’ to Uphold. the: Bill of Rights

Forum: Commonwealth College; Mena, Arkansas
Benjemin Davis Freedom Committees Communist Party, U. 8. A. its subdivisions, subsidiaries, and
Biack Dragon Goolety amliates

FORM 444d Use PREVIOUS EDITIONS -1- “)

RR ORES Sa aieties EE er es


14-0000

Communist Political Association, tts subdivisions, subaidiaries,
and affiliates, including:
Alabama People’s Educational Associstion
Florida Press and Educational League
Oklahoma League for Political Education
Peopic’s Educational and Press Association of Texas
Virginia League for People’s Education
Congress Against Discrimination
(800 Committee to Abolish Discrimination tn Maryiand)
Congress of American Revolutionary Writers
Congres of American Women
Congress cf the Unemployed
Connecticut Committee to Aid Victims of the Bmith Act
Connecticut State Youth Conference
Oouncil for Joba, Relief and Housing
Oouncil for Pan-American Democracy
Council of Greek Americans
Council on African Affairs
Croatian Benevolent Fraternity

Dai Nippon Butoku Kal (Military Virtue Boclety of Japan or Mill-
tary Art Society of Japan)

Dally Worker Press Chub

Daniels Defense Committees

Dante Alighiert Society (between 3635 and 1940)

Dennis Defense Committees

Detroit Youth Assembly

East Bay Peace Committee

Elsinore Progressive League

Emergency Conference to Gave Spanish Refugees (founding body
of the North American Spanish Ald Committee)

Everybody’s Oammittee to Outlaw War

Pamilies of the Baltimore Smith Act Victims

Pamilies of the Smith Act Victims

Pederatian of Italian War Veterans in the U. & A, Inc. (Assocta-
sione RNasionale Combsttenti Italiani, Federarione degli Stati
Uniti d’America)

Finnish-Americen Mutual Aid Society

Florida Press and Educational League (see Communist Politica)
Associstion)

Prederick Dougtass Educational Center

Freedam Stage, Inc. .

Friends of the New Germany (Preundo des Neuen Deutschlands)

Priends of the Soviet Unicon

Qaribaldl American Fraternal Society

George Washington Carver School, New York City

German-American Bund (Amerikadeutecher Volksbund)

German-American Republican League

German-American Vocational League (Deutache-Amerikaniscne
Berufsgemeinschalt)

Guardian Club °

Hariem Trade Union Council

Hlawaill Civil Liberties Committee

Fleimusha Kat, aleo known as Nokubei Heleki Gimusha Kal, Zaibel
Nihonjin, Heiyeku Gimushba Kai, and Zaibel Heimusha Bal (Jap-
nese Residing tn America Military Conscripts Association)

Hlellentc-American Brotherhood

Binode Kal (Imperial Japanese Reservists)

Pincmaru Kal (Rising Sun Flag Society —a group of Japanese
War Veterans) :

Hokubel Zaigo Shoke Dan (North American Reserve Officera Asso-
ciation)

Hollywood Writers Mobilisation for Defense

Hungarian-American Council for Democracy

Hungarian Brotherhood

Idaho Penston Union
Independent Party (Seattle, Washington)
{See Independent People’s Party)

Independent People’s Party
(See Independent Party)
Industrial Workers of the World
International Labor Defense
International Workers Order, ite subdivisions, subsidiaries and
amlistes
Japanese Association of America
Japanese Overseas Central Society (Kaigal Dobo Chuo Kat)
Japanese Overseas Convention, Tokyo, Japan, 1940
Japancee Protective Association (Recruiting Organiration)
Jefferson School of Social Acience, New York City
Jewish Culture Society
Jewish People’s Committee
Jewish People’s Praternal Order
Jixyoku linkal (The Committee for the Crisis)
Johneon-Porest Group
(See Johnsonites)
Johnasonites .
(Bee Johnson-Forest Group)
Joint Anti-Pasclsat Refugee Committee
Joint Council of Progressive Italian-Americans, Inc.
Joseph Wedemeyer Schoo! of Social Sclence, Bt. Louls, Missourt

EKibei Seinen Kai (Association of U. &. Citizens of Japanese An-
ceetry who have returned to America after studying tn Japan)

Enights of the White Camellia

Ku Klux Elan

Kyfflhacuser, also known as Kyffhacuser League (Xyffhaeuser
Bund), Eyffhacuser Pellowahip (Kyfthacuser Kameradachaft)

Kythaeuser War Relief (Kyffhaeuser Eriegahiifswerk)

Labor Council for Negro Rights
Labor Research Association, Inc.
Labor Youth League

League for Common Sense

League of American Writers

Lictor Bociety (Italian Black Shirts)

Macedonian-American People's League
Mario Morgantini Circle
Maritime Labor Committee to Defend Al Lannon
Maryland Congress Against Discrimination
(Bee Committee to Abolish Discrimination in Maryland)
Massachusetts Committee for the Bill of Rights
Massachusetts Minute Women for Peace (not connected with the
Minute Women of the U. 8. A. Inc.)
Maurice Braverman Defense Committee
Michigan Civil Rights Federation
Michigan Council for Peace
Michigan School of Social Gclence

Wanka Telkoku Gunyudan (Imperial Military Friends Group or
Southern California War Veterans)

National Association of Mezican Americans (also known as Asccia-
clon Nactonal Mexico- Americans) .

National Blue Star Mothers of America (not to be confused with
the Blue Star Mothers of America organized in February 1942)

National Committes for Freedam of the Press

National Committee for the Defense of Political Prisoners

National Committee to Win Amnesty for Smith Act Victims

National Committee to Win the Peace

National Conference on American Policy in Chins and the Par East
(@ Conference calied by the Committee for a Democratic Par
Eastern Policy)

National Council of Americans of Croatian Descent

National Council of American-Soviet Friendship

National Federation for Constitutional Liberties

National Labor Conference for Peace

Nationa! Negro Congress

National Negro Labor Council

Nationalist Action League


14.99000

Nationalist Party of Puerto Rico

Nature Priends of America (since 1935)

Negro Labor, Victory Committees

Kew Committee for Publications

Nichide! Kogyo Kaisha (The Great Fuji Theatre)
North American Committee to Ald Spanish Democracy
North American 6panish Ald Committce

North Philadelphis Forum

Northwest Japanese Association

Ohio School! of Bocial Sciences

Oklahoma Committee to Defend Political Prisoners

Oxiahoma League for Political Education (see Communist Politi-
cal Association)

Original Gouthern Elans, Incorporated

Pactfic Northwest Labor &chool, Beattie, Washington

Palo Alto Peace Club

Partido del Pueblo of Panama {operating in the Canal Zone)

Peace Information Center

Peece Movement of Ethiopia

People’s Drama, Inc.

People’s Educational and Press Association of Texas (see Commu
nist Political Association)

People’s Educational Association (incorperated under name Los

Educational Association, Inc.), also known as People’s

Educational Center, People’s University, People’s School

People’s Institute of Applied Religion

Peoples Programs (Seattle, Washington)

People’s Radio Foundation, Inc.

People’s Rights Party

Philadelphia Labor Committee for Negro Rights

Philadelphia School of Boctal Sclance and Art

Photo League (New York City)

Pittsburgh arts Club

Political Prisoners’ Welfare Committee

Polonia Society of the TWO

Progreastve German-Americans, also known as Progressive Ger-
man-Americans of Chicago

Proietarian Party of America

Protestant War Veterans of the United States, Inc.

Provisional Committee of Citizens for Peace, Bouthweet Aros

Provisional Committee on Latin American Affairs

Provisional Committee to Abolish Discrimination in the State of

Maryland
(Bee: Committees to Abolish Discrimination in Maryiend)

Puerto Rican Comite Pro Libertades Civiles (CLC)
(See Comite Pro Derechos Civiles)

Puertorriquenos Unidos (Puerto Ricans United)

Quad City Committee for Pesce
Queensbridge Tenants League

Revolutionary Workers League
Romanian-American Fraternal Society
Russian American Society, Inc.

Sakura Kal (Patriotic Goclety, oF Cherry Association — composed
of veterans of Russo-Japanese War)
Bamuel Adams School, Boston, Massachusetts

‘ Se ee ete

Banta Barbara Peace Porum

Gcbhappes Defense Committee

Gchnelderman-Darcy Defense Committee

Bchool of Jewish Btudies, New York City

Beattie Labor School, Beattie, Washington

Berdian-American Fraternal Society

Gerdian Vidordan Council .

Shinto Temples (limited to State Shinto abolished in 1945)

Olver Shirt Legion of America ”

@lavie Council of Southern California

Slovak Workers Society

Blovenian-American National Council

Goctalist Workers Party, including American Oommittee for Euro-
pean Workers’ Relief

Gokoku Kal (Fatheriand Society)

Southern Negro Youth Congress

Buiko Sha (Reserve Officers Association, Los Angeles)

Byracuse Women for Pesce

Tom Paine School of Social Science, Philadelphia, Pennsyivanis
Tom Paine School of Westchester, New York
Trade Union Committes for Peace
(See Trade Unionists for Peace)
Trade Unionists for Peace
(Bee Trade Unionista for Peace)
Tri-State Negro Trade Union Oouncil

Unrainian-American Fraternal Union

Union of American Croatians

Union of New York Veterans

United American Spenish Ald Committes

United Committee of Jewish Gocieties and Landsmanschaft Fed-
erations, also known as Coordination Oommittes of Jewish
Landsmapschaften and Praternal Organizations

United Committee of South Slavic Americans

United Defense Council of Southern California

United Hariem ‘Tenants and Consumers Organization

United May Day Committee

United Negro and Allied Veterans of America

Veterans Against Discrimination of Civil Rights Congress of New
York (see Civil Rights Congress)

Veterans of the Abraham Lincoln Brigade

Virginia League for People’s Education (see Communist Political
Association)

Voice of Freedom Committee

Walt Whitman School of Social Science, Newark, New Jereey
Washington Bookshop Association

Washington Committee for Democratic Action

Washington Committee to Defend the Bul of Rights
Washington Commonwealth Federation

Washington Pension Union

Wisconsin. Conference on Gocial Legislation

Workers Alliance (since April 1934)

Yiddlaher Kultur Parband

Young Communist League
Yugoslay-American Cooperstive Home, Inc.
Yugoelav Seamen's Club, Inc.

ay, we

a . ETM +.

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3h

al ‘Any phase of communications; administration; or personnel

i le

THIS DATE (Pill In)

September 6, 1961

1. Answer all questions completely or check appropriate box. If question is not applicable, write “NA”. Write “Un-
known” only if you do not know the answer and it cannot be obtained from personal records. Use blank space at
end of form for extra details on any question for which you have insufficient space.

2. Type, print or write carefully; illegible or incomplete forms will not receive consideration.

3. Consider your answers carefully. Your signature at the end of this form will certify to their correctness. Careful
completion of all applicable questions will permit review of your qualifications to the best advantage.

SECTION | GENERAL PERSONAL AND PHYSICAE”DAY
1. FULL NAME (Last+Firet-Middie)

eT ee
FLORES, Daniel PA 6 Pee ree

4, HEIGHT S. WEIGHT . 6. COLOR OF EYES 7. COLOR OF HAIR [APE COMPLEXION 9. TYPE BUILD
5+ 6" 165 pds. Brown Black } Dark
10. SCARS (Type end Location) Right cheek, one-half inch scar; left*upper Zip, one-

both received playing football

a
None
12. CURRENT ADDRESS (No., Street, City, Zone, State and Country)

2828 Connecticut Avenue,N. We, #20 / ; .
2828 Connecticut Avenue, N. W.
ashington 8, D. ©, & #203 - Washington 8, Dc.

- CURRENT PHONE NO. 15. OFFICE PHONE NO. & EXT. 16. LEGAL RESIDENCE (State, Territory or Country)
265-832 & None Washington, District of Columbia
18. OTHER NAMES YOU HAVE USED :
5 None

19. INDICATE CIRCUMSTANCES (Including Length of Time) UNDER WHICH YOU HAVE EVER USED THESE NAMES.

13. PERMANENT ADDRESS (No., Street, City, Zone, State and
Country) AND PHONE NO. x oe 6 3

NA -
SECTION I! POSITION DATA

1. INDICATE THE TYPE OF WORK OR POSITION FOR WHICH YOU ARE APPLYING

work.

2. INDICATE THE LOWEST ANNUAL ENTRANCE SALARY YOU WILL
not be conside: eeny position with a lower
entrence salary).

Pd
ra)
re)
mi
a
4
2
£
ES

we
ry

in)

[o)

io

(eo)

or
5

4 INDICATE YOUR WILLINGNESS TO TRAVEL

DATE AVAILABLE FOR EMPLOYMENT
- Immediately
| Joccasronsuuy ] Yewccuentiy [ Jeowstanrey | [orem

5. INDICATE YOUR WILLINGNESS TO ACCEPT ASSIGNMENT IN THE FOLLOWING LOCATIONS (Check (X) each item applicable)

PXoursioe contimenvac uss,
6. INDICATE WHAT RESERVATIONS YOU WOULD PLACE ON ASSIGNMENTS OUTSIDE THE WASHINGTON, D.C. AREA.

I would be willing to travel within the United States provided
said travel would not involve a permanent move whereby my le gal
residence would be changed. However, it is my wish to live overseas
on a permanent Dasis. ;

(a

FORM 444 USE PREVIOUS EDITION. DY COONEY ee

14-0000

15. DATE OF ARRIVAL IN U.S. 16. PORT OF ENTRY 17. ON PASSPORT OF WHAT COUNTRY
NA NA NA
NA NA
@ | SECTION IV - EDUCATION

rr er ra

United States of America
af NATURAL- 6. NATURALIZATION CERTIFICATE NO.
"WA NA

7, COURT ISSUING NATURALIZATION CERTIFICATE 8. ISSUED AT (City, State, Country)
NA NA
9. HAVE YOU HELD PREVIOUS NATIONALITY 10. iF YES, GIVE NAME OF COUNTRY

P[res dL X NA

11, GIVE PARTICULARS CONCERNING PREVIOUS NATIONALITY.

NA

13. GIVE PARTICULARS
12. HAVE YOU TAKEN STEPS TO CHANGE [ves | .
PRESENT CITIZENSHIP . ca
f

N
IF YOU HAVE APPLIED FOR U.S. CITIZENSHIP, WHAT IS PRESENT STATUS OF YOUR APPLICATION (First Papere, Etc.)?

NA

14.

1. CHECK (X) HIGHEST LEVEL OF EDUCATION ATTAINED

LESS THAN HIGH SCHOOL GRADUATE OVER TWO YEARS OF COLLEGE - NO DEGREE

IGH SCHOOL GRADUATE || BACHELOR'S RBEGREE

TRADE, BUSINESS, OR COMMERCIAL SCHOOL GRADUATE GRADUATE STUDY LEADING TO HIGHER DEGREE
Two YEARS COLLEGE OR LESS MASTER'S DEGREE a DOCTOR'S DEGREE

2. ELEMENTARY SCHOOL ’
« ADDRESS (City, S: Country)

0

an Marcos,) Texas A

,

Pe | |

1. NAME OF BLEMENTAF SCROOL ” tate,

Ban Marcos)Elementary School”
3. DATES ATTENDED (From-end-To)

~» 19h2 - May, 1951 - [xX[ves no

¢2]
o
ct

1. NAME OF HIGH SCHOOL “T 2. ADORESS (City, State, Country)

Gan Marcos) High School ; ~ 6an Marcos,) Texas, U.S.A. ° .

3. DATES AT TENDED (From-and-To) “40 4. GRADUATE

Sept., 1951 - May, 19

1. NAME OF HIGH SCHOOL . ADDRESS (City, State, Country)

iS)
QZ
|
|

ro
RY
|

f\

5 baves ATTENDED Fomana Ta ema
: 4. COLLEGE OR UNIVERSITY STUDY

SUBJECT DATES ATTENDED DATE SEM/QTR
[ xo | ReC'O | Grocity
[erom [v0 Gomctt)

. SECTION IV CONTINUED TO PAGE 3
. - * . Ey, . =


14.90000

rf sree
SECTION IV CONTINUED FROM PAGE 2

EO IN ITEM 4 WHICH REQUIRED SUBMI '
iTS CONTENT- BMISSION OF A WRITTEN THESIS, INDICATE THE TITLE

6. TRADE, COMMERCIAL AND SPECIALIZED SCHOOLS

8. OTHER EDUCATIONAL TRAINING NOT INDICATED ABOVE.

Weapons Training in Marine Corps. ;
Acted as partisan during cold weather training at Bridgeport,
California (Pickle Meadows = USMC).

a 3

@ | SECTION V FOREIGN LANGUAGE ABILITIES

COMPETENCE - IN ORDER LISTED
1. LANGUAGE _ R-Reed, W-Write, S-Speak
(Liat below each language in

which you poesess any degree FLUENT

of competence. Indicate your — BUT

Proficiency to Read, Write or opyiousty

Speak by placing a check (X)

in the appropriate box(es).

2. IF YOU HAVE CHECKED “ACADEMIC STUDY" UNDER *HOW ACQUIRED”, INDICATE LENGTH AND INTENSIVENESS OF STUDY.

NA

YOU HAVE INDICATEO FLUENCY FOR A LANGUAGE HAVING SIGNIFICANT DIFFERENCES IN SPOKEN AND WRITTEN FORM, EX-
AIN YOUR COMPETENCE THEREIN.

NA

4. DESCRIBE YOUR ABILITY TO DO SPECIALIZED LANGUAGE WORK INVOLVING VOCABULARIES AND TERMINOLOGY IN THE SCIEN-
TIFIC, ENGINEERING, TELECOMMUNICATIONS, MILITARY, AND OTHER SPECIALIZED FIELDS.

Could act as literal interpreter at almost any level.

3. IF YOU HAVE NOTED A PROFICIENCY IN LANGUAGE, WOULD YOU BE WILLING TO USE THIS ABILITY IN ANY POSITION FOR WHICH
YOU MIGHT SE SELECTED? .


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‘ ‘ a

SECTION VI GEOGRAPHIC AREA KNOWLEDGE AND FOREIGN TRAVEL

1. LIST BELOW ANY FOREIGN REGIONS OR COUNTRIES IN WHICH YOU HAVE TRAVELLED OR GAINED KNOWLEDGE AS A RESULT OF
RESIDENCE, STUDY OR WORK ASSIGNMENT. INDICATE TYPE OF KNOWLEDGE SUCH AS TERRAIN, HARBORS, UTILITIES, RAIL-
ROADS, INDUSTRIES, POLITICAL PARTIES, ETC.

KNOWLEDGE ACQUIRED BY

pd T v T y | ASSIGNe
RAVELIS
ENCE : up MENT

Marine Security Guard - American Embassy - Bolivia and Peru
Vacation - Chile; Argentina; Uruguay; Panama

3. UNITED STATES PASSPORT NUMBER AND EXPIRATION DATE, IF ISSUED.

No. (171850 °%SP-85575)) Passport has been cancelled.

SECTION Vil TYPING AND STENOGRAPHIC SKILLS

1. TYPING (wpm) | 2. SHORTHAND(wpnv 3. SHORTHAND SYSTEM USED - CHECK (X) APPROPRIATE ITEM
5 wpm | None | [ence | [arccownirine | [stenorvee | [owen (pecity)
2. INDICATE OTHER BUSINESS MACHINES WITH WHICH YOU HAVE HAD OPERATING EXPERIENCE OR TRAINING (Comptometer,

Mimeogmph, Card Punch, Etc.).

Thermofax, mimeograph, switchboard

DATES OF

TYPE OF
SPECIALIZED KNOWLEDGE RESIDENCE

otisia oman moana VES P|
Bolivia General knowledge £0
a
fone | Cider
Chile 9
Argentina | 6/30 /59
Uruguay 59

2. INDICATE THE PURPOSE OF VISIT, RESIDENCE, OR TRA

DATES AND
PLACE OF STUDY

NAME OF
REGION OR COUNTRY

General knowledg

SECTION Vil! SPECIAL QUALIFICATIONS 4
1. List ALL HOBBIES AND SPORTS IN WHICH YOU ARE ACTIVE OR HAVE ACTIVELY PARTICIPATED. INDICATE YOUR PROFICIENCY

Foot ball - good
Basketball - fair
Swimming _ > = .good
Reading :- average

Contract.Bridge - very good.

- INDICATE ANY SPECIAL QUALIFICATIONS

RESULTING FROM EXPERIENCE OR TRAINING WHICH MIGHT FIT YOU FOR A
PARTICULAR POSITION OR TYPE OF WORK.

None to my knowledge

+ EXCLUDING BUSINESS EQUIPMENT OR MACHINES WHICH YOU MAY HAVE LISTED IN ITEM 2, SECTION VII, LIST ANY SPECIAL
SKILLS YOU POSSESS RELATING TO OTHER EQUIPMENT AND MACHINES SUCH AS OPERATION OF SHORTWAVE RADIO (Indi-
cate CW epeed, sending and receiving), OF FSET PRESS, TURRET LATHE, SCIENTIFIC AND PROFESSIONAL DEVICES.

None

SECTION VIII CONTINUED TO PAGE 5
7 Ta

14.90000

Seen

SECTION Vill CONTINUED FROM PAGE 4

4. ARE YOU NOW OR HAVE YOU EVER BEEN A LICENSED OR CERTIFIED MEMBER OF ANY TRADE OR PROFESSION, SUCH AS PILOT,
ELECTRICIAN, RADIO OPERATOR, TEACHER, LAWYER, CPA, MEDICAL TECHNICIAN, ETC.? y 00

T es NO

S. IF YOU HAVE ANSWERED *YES® TO ABOVE, INDICATE KIND OF LICENSE AND STATE ISSUING LICENSE (Provide License Registry
Number, tf known).

NA

6. FIRST LICENSE OR CERTIFICATE (Year of Issue) 7. LATEST LICENSE OR CERTIFICATE (Year of Iaaue)

8. LIST ANY SIGNIFICANT PUBLISHED MATERIALS OF WHICH YOU ARE THE AUTHOR (Do NOT eubmit copies unless requested). INDICATE
TRE

z ITE LP UBLICATION DATE, AND TYPE OF WRITING (Non-Fiction of Scientific articles, General Intereat subjects, Novels, Short
tories, Ete). i. oar

None

9. INDICATE ANY DEVICES WHICH YOU HAVE !NVENTED ANO STATE WHETHER OR NOT THEY ARE PATENTED.

None

10. LIST PUBLIC SPEAKING AND PUSLIC RELATIONS EXPERIENCE.

Have spoken in my father's church and other churches approximately
150 times. Met and assisted public in Embassies during my tour of
with the Marine Security Guard

11. LIST ANY PROFESSIONAL, ACADEMIC OR HONORARY ASSOCIATIONS OR SOCIETIES IN WHICH YOU ARE NOW OR WERE FORMERLY
A MEMBER. LIST ACADEMIC HONORS YOU HAVE RECEIVED.

None

SECTION IX 2 EMPLOYMENT HISTORY

NOTE: (LIST LAST POSITION FIRST.) Indicate chronologicdé! history of emptoyment for past 15 years. Account for all periods
including casual employment and ail periods of unemployment. Giveaddress and state what you did during periodsof
unemployment. List all civilian employment by a foreign Govemment, regardless of dates. In completing item 9, “De-

scription of Duties” consider your experience carefully and provide meaningtul, objective statements,

1. INCLUSIVE DATES (From and To - By Mo. and Yr.) 2. NAME OF EMPLOYING FIRM OR AGENCY
\Hiliburn's\Drug Store
0

3S. NAME OF SUPERVISOR 0G
Mr illiam (Hillbu

7. SALARY OR EARNINGS 8. CLASS, GRADE(If Federal Service)
#1.00,00

Ountain enda
9. DESCRIPTION OF DUTIES

Employee at soda counter

10. REASONS FOR LEAVING .

To participate in school events (football).

SECTION IX CONTINUED TO PAGE 6

-3- SF

14-0000

. : ae SECTION IX CONTINUED FROM PAGE 5

1. INCLUSIVE DATES (From and To - By Mo. and Yr.)

July 195y-dune 1955

2. NAME OF EMPLOYING FIRM OR AGENCY
(Diamond)Grocery Store

= Se :
South Guadalupe St. San Marcos

4. KIND OF BUSINESS 5. NAME OF SUPERVISOR

vir. (Ignacto Gonzales) %6

6. TITLE OF JOB j & CLASS, GRADE (If Federal Service)
Butcher [s3U,00 [ren Week |

9. DESCRIPTION OF DUTIES

Slaughtering and preparing meat for sale as well-as actual selling.

10. REASONS FOR LEAVING

To attend college

1. INCLUSIVE DATES (From and To - By Mo. and Yr.)
ay 9 - September
3. ADDRESS (No., Street, City, State, Country)
San. Marcos)? Texas
Private School Y onn Darkman 9
6. TITLE OF JOB 8. CLASS. GRADE (If Federal Service)
Painter's Assistant Ts 35,00 [FER week |

9. DESCRIPTION OF DUTIES

Painted dormitories in the Academy

10. REASONS FOR LEAVING

To attend school

2. NAME OF EMPLOYING FIRM OR AGENCY
Economy )Department Stores

1. INCLUSIVE DATES (From and To - By Mo. and Yr.)
September, 1956 - July, 1957
3. ADORESS (Nv., Street, City, State, Country)
San Marcos }i0Texas .
s KIND OF BUSINESS 5. NAME OF SUPERVISOR ob
Clothing Store . Mr. (Max Mendlovitz_
6. TITLE OF JOB 8. CLASS. GRADE (If Federal Service)
Sales Clerk s 30,00

9. DESCRIPTION OF DUTIES

Assisted customers in selecting and buying goods.

10. REASONS FOR LEAVING

-To join the Marine Corps.

2. NAME OF EMPLOYING FIRM OR AGENCY

1. INCLUSIVE DATES (From and To - By Mo. and Yr.)

wy 26, 19 - July 2 1961 United States Marine Corps
3. ADDRESS (No., Street, City, State, Country)
Marine Corps Schools, Quantico, Virginia
4. KIND OF BUSINESS 5S. NAME OF SUPERVISOR
Military . - 1Gol. John Magruder
6. TITLE OF JOB ®. CLASS. GRADE (If Fodera! Service)
)

Marine Corps Museum Attendant |s 100.00 |rermontH Cpl. (E-
SECTION IX CONTINUED TO PAGE 7

- ot ; SS

miu

14-0000

oa os (

"9. DESCRIPTION OF DUTIES
Acted as guide to all visitors entering Museum, explaining
Marine Corps history, etc. Also on several occasions acted as
interpreter for visiting military personnel from Latin America,

10. REASONS FOR LEAVING
2. NAME OF EMPLOYING FIRM OR AGENCY
06 (Ohio Valley) Engineering Company

Dis charged

1. INCLUSIVE DATES (From and To - By Mo. and Yr.) .
July 28, 1961 - August 30, 1961
3. ADDRESS (No., Street. City, State, Country) . . .

. Capitbl and I Streets, S. W.), Washington, D. CG.

Construction Mr.(L. G. Bruce) 0G

"Laborer. a .
Service)
Laborer rer Hour

9. DESCRIPTION OF DUTIES

Handyman for Company

4. KIND OF BUSINESS : 5. NAME OF SUPERVISOR
6. TITLE OF JOB : 7. SALARY OR EARNINGS

9. DESCRIPTION OF DUTIES

8. CLASS. GRADE (If Federal
Service)

10. REASONS FOR LEAVING

8. IF PRIOR SERVICE WITH THE FEDERAL GOVERNMENT 1S NOTED ABOVE, INDICATE THE
MUMBER OF YEARS CREDITABLE TOWARD U.S. CIVIL SERVICE RETIREMENT, iF KNOWN. 7 1/2 years
.

8S. HAVE YOU EVER BEEN DISCHARGED OR ASKED TO RESIGN FROM ANY POSITION. i YES [ono

HAVE YOU LEFT A POSITION UNDER CIRCUMSTANCES WHICH YOU DESIRE TO EXPLAIN? (Clves [Ano
IF YOUR ANSWER TO EITHER OR BOTH QUESTIONS IS “YES®, GIVE DETAILS

‘

Honorably discharged from United States Marine Corps.


14.90000

SECTION Xt MILITARY SERVICE

1. CURRENT DRAFT STATUS

1. ARE YOU REGISTERED FOR THE ORAFT UNDER YES | 2. SELECTIVE SERVICE CLASSIFF | 3. SELECTI RVICE NO.
THE UNIVERSAL MILITARY TRAINING AND | X [ves] CATION VE SERVIC
SERVICE ACT OF 1948 (As amended) | [wo | IV-A {1-65-35-18 Jb

4. IF OEFERRED, GIVE REASON S, LOCAL ORAFT BOARD NO. OR DESIGNATION AND ADDRESS
NA G65 - 101 1/2 BE. San antonio st. ,0%
2. MILITARY SERVICE RECORD (yp (Lockhart ,) Texas

1. CURRENT AND/OR PAST ORGANIZATIONAL MEMBERSHIP

CHECK [X) AS MARINE AIR COAST NATIONALIAIR NAT*L| FOREIGN ORGAN. OR MIL.
APPROPRIATE ARMY NAVY CORPS FORCE | GUARD SuarD | GuaRD | SERVICE (Specify):

4. TOTAL LENGTH OF EXTENDED ACTIVE S. ARM,
FORCES (Poet ond current ENDED ACTIVE DUTY IN U MED
years :

CURRENT SERVICE 6. TOTAL LENGTH OF ACTIVE DUTY IN FOREIGN MILITARY OR-
GANIZATION

26 July,1957 ~
7. RANK, GRADE OR | PAST SERVICE CURRENT SERVICE 6. SERVICE, SERIAL OR FILE NUMBER (If now serving, provide cur-
RATE > Cc 1 E rent number)
pi. —

9. PRIMARY MILITARY OCCUPATIONAL PAST SERVICE CURRENT SERVICE
SPECIALTY (Moe or Deasignator) AND TITLE
Olyl - Chief Clerk
10. SECONDARY MIL. OCCUPATIONAL PAST SERVICE CURRENT SERVICE
SPECIALTY (Moe or Designator) AND
TITLE ; None

i. BRIEF DESCRIPTION OF MILITARY DUTIES (Indicate whether applicable to pest of current service)
Past Service: Clerk - Maintained personnel service records.
2 years as Security Guard in the American Embassies in
La Paz, Bolivia and Lima, Peru.

None

ersonne AGMINnA § =| OF)
3. DATE SEPARATEO FROM EXTENDED ACTIVE DUTY (Paat servicg

5. DATE ENTERED
ACTIVE DUTY =

12. CHECK (X) TYPE OF SEPARATION FROM ACTIVE DUTY

X/ RELEASE TO INACTIVE DUTY |_| RETIREMENT FOR COMBAT DISABILITY |
Previnewen ronsce | [wermenent ron envatcnconaonny —] [on
13. CHECK (X) COMPONENT IN WHICH YOU SERVED
X [Resuian |X] RESERVE (Including the National and Air National Guard) r | OTHER (Including AUS)
3. MILITARY RESERVE, NATIONAL GUARD AND ROTC STATUS
1, DO YOU NOW HAVE; 2. ARE YOU NOW A MEMBER OF THE YES 3. ARE YOU NOW A MEMBER OF

YES
RESERVE STATUST x NAT'L. GRD. OR AIR NATAL. THE ROTC? | |
[two | Sant X [no x

4. IF YOU HAVE ANSWERED “YES” TO ITEMS 2,2 OR 3 ABOVE, CHECK COMPONENT MEMBERSHIP BELOW

[pron X ranine conrd — [warvonaccuanq  [coastovano] [wavy ore | WDIcATE move CATEGORY Now
[pavd [am ronce [aim warouana{ [anwy qore | [am ronce nord on

5. CURRENT RANK, GRADE OR 6 DATE OF APPOINTMENT IN CURRENT |7. EXPIRATION DATE OF CURRENT RESERVE OBLIGA-
N
RATE Cpl, (E- May, 1959 January 20, 1962
8. CHECK (X) CURRENT RESERVE CATEGORY | [READY RESERVE] _ |STANDEY(Active)]| X [STANDBY(Inactive)| | RETIRED

9. PRIMARY MILITARY OCCUPATIONAL SPECIALTY (Mas or Dosig- |10. SECONDARY MILITARY OCCUPATIONAL SPECIALTY (Moa or Dee-
netor) AND TITLE . - ignator) AND TITLE * .

O11 None

1. BRIEF DESCRIPTION OF MILITARY RESERVE DUTIES

i
m
yy

None

12. ARE YOU CURRENTLY ASSIGNED OR ATTACHED YES | 13. IF YOU HAVE ANSWERED “YES” TO ITEM 12, GIVE UNIT OR AGENCY
TO A RESERVE, NAT'L. GUARD OR ROTC TRAIN- AND AODRESS oe
ING UNIT 3 ix {ro |

16. HAVE YOU A MILITARY MOBILIZATION Assion- |_| 15. IF YOU HAVE ANSWERED “YES” TD ITEM 14, GIVE UNIT OR AGENCY
MENT? : eto NO ADORESS :

16. iNDICATE- TOTAL MILITARY SERVICE] YEARS MONTHS 17. WHERE ARE YOUR SERVICE RECORDS KEPT?

-FOR LONGEVITY PURPOSES INCLUD-
ING ACTIVE AND INACTIVE DUTY 7 Headquarters Mar*ne Corps

ef


14-0000

4 rr a ‘
SECTION XI - FINANCIAL STATUS

1-ARE YOW ENTIRELY DEPENDENT ON YOUR SALARY? (lves KK]no
2. IF YOUR ANSWER IS "NO" TO THE ABOVE, STATE SOURCES OF OTHER INCOME

Wife's income

3. BANKING INSTITUTIONS WITH WHICH YOU HAVE ACCOUNTS

NAME OF INSTITUTION ADDRESS (City, State, Country)

0 eWe O Avenue,

4. HAVE YDU EVER SEEN IN, OR PETITIONED FOR, BANKRUPTCY, (] ves [X]no
5. 1F YOUR ANSWER IS "YES" TO THE ABOVE, GIVE PARTICULARS, INCLUDING COURT AND DATE(S)

6. GIVE THREE CREDIT REFERENCES IN THE UNITED STATES

NAME * ADDRESS (No., Street, City, State)
General Motors Acceptance Corp. Portland 5, Oregon
P.O. Box 725,
Gulf Oil Corporation Atlanta 9, Georgia
917 Caroline Steet,
Ninde Furniture Company Fredericksburg Virginia
7. DO YOU RECEIVE AN ANNUITY FROM THE UNITED STATES OR DISTRICT OF COLUMBIA GOVERNMENT UNDER ANY RETIREMENT
ACT, PENSION, OR COMPENSATION FOR MILITARY OR NAVAL SERVICE? ‘| YES fx] NO

6. 1F YOUR ANSWER 1S “*YES*’* TO THE ABOVE QUESTION, GIVE COMPLETE DETAILS

9. DO YOU HAVE ANY FINANCIAL INTEREST IN, OR OFFICIAL CONNECTIONS WITH NON-U.S. CORPORATIONS OR BUSINESSES: OR IN
OR WITH U.S. CORPORATIONS OR BUSINESSES HAVING SUBSTANTIAL FOREIGN INTERESTS?

("] ves . NO (If anewer “YES®, fumish details on separate sheet.)

SECTION XII MARITAL STATUS
1. PRESENT STATUS (Single, Married, Widowed, Separated, Divorced, or Annulled) SPECIFY: Married
2. STATE OATE, PLACE, AND REASON FOR ALL SEPARATIONS, DIVORCES OR ANNULMENTS

NA . °

WIFE, HUSBAND If you have been married more than once - including annulments - use a separate sheet for former wife or
OR FIANCE: husband giving data required below for all previous marriages. If marriage contemplated, fill in appropriate
. information for fiance. .

3. NAME (First) : (Middle) {Maiden) —~(Last) + 4

Dorothy anne _ 96 _arnett

4. STATE ANY OTHER NAMES EVER USED INDICATE CIRCUMSTANCES (Including length of time) UNDER WHICH ANY
OF THESE NAMES WERE USED. IF LEGAL CHANGE GIVE PARTICULARS
(Where and by what authority). USE EXTRA SPACE PROVIDED ON PAGE 16
OF THIS FORM TO RECORD THIS INFORMATION.

Dorothy A, Moran

N.W. j 24
12. DATE OF BIRTH 18. PLACE OF BIRTH (City, State, aan 14, CITIZENSHIP
January 31, 1935 Portland, Oregon United States of

SECTION XII CONTINUED TO PAGE 10

9. 597

14.99000

rr i -10-

SECTION XU CONTINUED FROM PAGE 9 .

14. IF BORN OUTSIDE U.S. - DATE OF ENTRY 15. PLACE OF ENTRY
NA -* : ay NA . oo.

16. FORMER CITIZENSHIP(S) Country(iee)7 17, DATE U.S. CITIZENSHIP 78. WHERE ACQUIRED (City, State, Country)

NA NA NA
19. OCCUPATION 20. PRESENT EMPLOYER (Also give former employer, or if spouse deceased or
7 . employed give last two employers) S
Legal Secretary* (Boykin and De Francis) d 0
Former: epartment of State
1. EMPLOYER'S OR BUSINESS ADDRESS (No., Street, City, State, Country)

1.000 16th St., NoW., Suite 603) Washington 6, D.C

22. DATES OF MILITARY SERVICE (From and to - Sy Mo. and Yr.)

None

23. BRANCH OF SERVICE - ~ 24. COUNTRY WITH WHICH MILITARY SERVICE AFFILIATED

25. DETAILS OF OTHER GOVERNMENT SERVICE, U.S. OR FOREIGN Pope ign Service - Jan., 1958 - Oct.,
1960: Civil Service - April] 196) - June 1961
SECTION XIII CHILOREN AND OTHER DEPENDENTS e

1. PROVIDE THE FOLLOWING INFORMATION FOR ALL CHILDREN AND DEPENDENTS

[”~”~C~SNAME RELATIONSHIP | DATE AND PLACE OF BIRTH | CITIZENSHIP ADDRESS

3. NUMBER OF OTHER DEPENDENTS (inctuding epous
parents, step-perents, alster, etc.) WHO OEPEND ON
YOu FOR AT LEAST 50% OF THEIR SUPPORT, OR
CHILOREN OVER 21 YRS. QF AGE WHO ARE NOT
SEL F-SUPPORTING. .

2. NUMBER OF CHILDREN (Including ate,
children and doce e

edopted children) WHO ARE
UNMARRIED, UNDER 2! YRS. OF AGE,
ANO NOT SELF-SUPPORTING.

SECTION XIV FATHER (Give same information, for Stepfather and/or Guardian on @ separate sheet) e
Jose S, Flores x [ves F

TAG TER NAMES HE HAS USED INDICATE CIRCUMSTANCES (Including length of time) UNDER WHICH HE HAS
EVER USED THESE NAMES. IF LEGAL CHANGE, GIVE PARTICULARS (Where
and by what authority). USE EXTRA SPACE PROVIDED ON PAGE 16 OF THIS

FORM TO RECORD THIS INFORMATION.

=. FUN OL. ES AC
10. IF BORN OUTSIDE U.S. - DATE OF ENTRY 1%. PLACE OF ENTRY . . .
May 2h, 1918 Unknown a
12. FORMER CITIZENSHIP(S) (Country(ies)7 |,19., DATE U.S. CITIZENSHIP 14. WHERE ACQUIRED (City, State, Country)
ACQUIRED
Mexican : 9 . +» Austin AXAS
15. OCCUPATION 16. PRESENT EMPLOYER (Givo last employer, if Father is deceased or unemplayod)
Baptist Minister Mexican Baptist Church
17. EMPLOYER'S BUSINESS ADORESS OR FAT *S SUSINESS ADDRESS IF SELF-EMPLOYEO

ILITARY, SERVICE (From-and-To,

CATES OF M
my know edge never

21, DETAILS OF OTHER GOVERNMENT SERVICE, U.S. OR FOREIGN

= | SY

14.90000
iseohy

» ‘| SECTION XV
1. FULL NAME (Laet-Piret-Middle)

__Flores,(agustina )a

8. STATE OTHER NAMES SHE HAS USED

None to knowledge

3. DATE OF DEATH 4. CAUSE OF DEATH

June 1939 Unknown
DMST ANCES (incliding length of time) UNDER WHICH SHE HAS
SE NAMES. IF LEGAL CHANGE, GIVE PARTICULARS (Where
thority). USE EXTRA SPACE PROVIDED ON PAGE 16 OF THIS

6. CURRENT ADDRESS - GIVE LAST ADORESS, IF DECEASED (No., Street,

S. Austin and Lee Streets
ATE OF BIRTH

San Marcos

: 7 OD 8. PLACE OF BIRTH (City, State, Country) ee a
September 20, 19034 Mier y Noriega, Nuevo Leon, Mexico VMiexican \ |

10. IF BORN OUTSIDE V.5.~ DATE OF ENTRY 11, PLACE OF ENTRY

Unknown
12, FORMER CITIZENSHIP(S) /Country(iee)7
NA
15. OCCUPATION
Housewife

ACQUIRED

Unknown

15. DATE U.S. CITIZENSHIP | 14. WHERE ACQUIRED (City, State, Couha
NA NA

16. PRESENT EMPLOYER (Give last employer, if Mother ia deceased or unemployed,

N.

17, EMPLOYER’S BUSINESS ADDRESS OR MOTHER'S BUSINESS ADDRESS IF SELF EMPLOYEO

NA

18, DATES OF MILITARY SERVICE (Fronrend-To) 19. BRANCH OF SERVICE 20. COUNTRY

NA

21, DETAILS OF OTHER GOVERNMENT SERVICE, U.S. OR FOREIGN

> | SECTION XVI

1. FULL NAME (Last-F iret-Middlo)

(Patlan, Francés Dob

Renteria Rachel)o&

4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)

11 Lambert St.$°San Antonio

I FULL NAME (Lact-F iret-Middie)

Black, Rebecca Mary)?6

4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)
San Marcos,) Texas

01 S. Guadalupe st

1 FULL NAME (Laat-Firat-Middile,

Flores ,/Samue1\0

—

Wo., Street, City, Zone, State, Country)
i | Texas

g
Route 2, Box 320, San Marcos
FULL NAME, (Last-Firat-Middle) °

Bruce, Esther
. " oe City, Zone, State, Country)

7 FULL NAME (Last-F irat-Middle)
Flores, (Eleazar, 0G |

Texas

NA NA

BROTHERS AND SISTERS (Including Half-, Step- and Adopted Brothers and Sisters)

2. RELATIONSHIP 3. CITIZENSHIP (Country)
Sister U.S. of America
3. LIVING

3. CITIZENSHIP (Country)
U.S. of America

6. AGE

: K [ves | [xo | 39
2. RELATIONSHIP 3. CITIZENSHIP (Country)
Sister U.S. of America
K[res | [xo |
Brother U.S. of America
S. LIVING 6. AGE

X[rves | [xo | 32

3. CITIZENSHIP (Country)

U.S. of America

PXives | [xo | 2g

2. RELATIONSHIP 3. CITIZENSHIP (Country)
Sister U.S. of america
3S. LIVING 6. AGE

iX[ves| jo] 2

3. CITIZENSHIP (Country)

U.S. of America

2. RELATIONSHIP
Sister

2. RELATIONSHIP

-Brother

2. RELATIONSHIP

Brother

4. CURRENT AODRESS (No., Street, City, Zone, State, Country)

Dec eased
1. FULL NAME (Last-Firat-AMiddle)
Flores, (Juan)o6
4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)

De Ceased

ee] 7 |
2. RELATIONSHIP 3. CITIZENSHIP (Country)
U.S. of America
3. LIVING 6. AGE

PD Tves [XT xo | NA


14.90000

SECTION XVII FATHER-IN-LAW e
¥, FULL NAME (Last-Firet-Middle) 2. LIVING 3. DATE OF DEATH 4. CAUSE OF DEATH

‘Arnett, Carl Raymond) 74 XT | [so]

$3. STATE OTHER NAMES HE HAS USED INDICATE CIRCUMSTANCES (Including tength of time) UNDER WHICH HE HAS
EVER USED THESE NAMES. IF LEGAL CHANGE, GIVE PARTICULARS (Where
and by what authority). USE EXTRA SPACE PROVIDED ON PAGE 16 OF THIS
FORM TO RECORD THIS INFORMATION.

Ray

6. CURRENT OR LAST ADORESS (No., Street, City, State, Country) OO

505 Washington St., Milwaukie, 22,) Oregon

4S" DATE OF BIRTH 8 PLACE OF BIRTH (City, State, Country)

9. CITIZENSHIP

‘January 2, 1909 -j{ Minot, North Dakota U.S. of america
10, 1F BORN OUTSIDE U.S.- DATE OF ENTRY 11. PLACE OF ENTRY
WA NA .
12. FORMER CITIZENSHIPIS) LCountry(ies)) 13. DATE U.S. CITIZENSHIP 14. WHERE ACQUIRED (City, State, Country)
NA . ACQUIRED NA NA

16. PRESENT EMPLOYER (Give last employer, if Father-in-Law is deceased or unemployed)

Wilhelm Inc), Portland, Oregon

18. OCCUPATION .
| Warehouse -Foreman
‘SECTION XVID - OD MOTHER-IN-LAW

e
| fompkins alma. Des
| fompkins, Alma Dean)oG Ke po

5. STATE OTHER NAMES SHE HAS USED INDICATE CIRCUMSTANCES (Including length of time} UNDER WHICH SHE HAS
EVER USED THESE NAMES. IF LEGAL CHANGE, GIVE PARTICULARS (Where

ob and by what authority). USE EXTRA SPACE PROVIDED ON PAGE !6 OF THIS
Alma Dean Arnett 03 FORM TO RECORD THIS INFORMATION.
—

6. CURRENT OR LAST ADDRESS (No., Street, City, State, Country) rere,

(13920 8.E. Portland View Place, Portland 36, Oregon
7. DATE OF BIRTH 8. PLACE OF BIRTH (City, State, Country)
May 1910 -+ Portland, Oregon U.S. of Americg
10. IF BORN OUTSIDE U.S. - DATE OF ENTRY We PLACE OF ENTS
| WA

12. FORMER CITIZENSHIP(S) LCountryfies}7 13. DATE U.S. CITIZENSHIP 14, WHERE ACQUIRED (City, State, Country)

RA .: _ AeauinED NA Na

OCCUPATION 16. PRESENT EMPLOYER (Give last employer, tf Mother-in-Law is deceased or unemployed)

SECTION XIX RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO EITHER (1) LIVE ABROAD,
. (2) ARE NOT U.S. CITIZENS OR (3) WORK FOR A FOREIGN GOVERNMENT

FULL NAME (Last-Firat-Middle) .
None to my. knowledge

3. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES S. EMPLOYED BY
6. CITIZENSHIP (Country) . «77 FREQUENCY OF CONTACT PATE OF SAS omen
° .

8. DATE OF LAST CONTACT

1. FULL NAME (Laest-First-Middle) 2. RELATIONSHIP Pace |

4, ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES 8. EMPLOYED BY

6. CITIZENSHIP (Country) 7. FREQUENCY OF CONTACT 8. DATE OF LAST CONTACT

1, FULL NAME (Last-First-Middie) 2. RELATIONSHIP

@. ADDRESS OR COUNTRY IN WHICH “ELATIVE RESIDES 5. EMPLOYED BY

6. CITIZENSHIP (Country) 7. FREQUENCY OF CONTACT 8. DATE OF LAST CONTACT

1. FULL NAME (Last-First-Middle) . 2. RELATIONSHIP
4. ADORESS OR COUNTRY IN WHICH RELATIVE RESIDES 5S. EMPLOYED BY
ry :
6. ‘CITIZENSHIP (Country 7. FREQUENCY OF CONTACT 8. DATE OF LAST CONTACT
5 ee

SECTION XIX CONTINUED TO PAGE 13
Jilirhetiaintpatatashlnietanion enn nae nee cena nanEEEEED

oO

old

14-0000

——$——— ee
SECTION XIX CONTINUED FROM PAGE 12
6. SPECIAL REMARKS, IF ANY, CONCERNING RELATIVES NOTED IN SECTION XIX ABOVE

NA

. RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO ARE IN THE MILITARY OR CIVIL
© | SECTION Xx . SERVICE OF THE UNITED STATES °

1. NAME (Lest-First-Middie) 2. RELATIONSHIP . 4. CITIZENSHIP

Arnett, Raymond Wesley 9G * | Bro-in-law |U.S. of America

ODRESS (No., Street, City, State, Country)

U.S. Army Depot, Pueblo, Colorado

1. NAME (Leat-Firat-Middle) 2. RELATIONSHIP 4. CITIZENSHIP
- = 2 °
2nd Cousin U.S. of America

6. TYPE AND LOCATION OF SERVICE (If known)

Air Station, ¢ : _ Aviation - lst Sgt., USMC

1. NAME (Laat-Pirat-Middle) 2. RELATIONSHIP pee CITIZENSHIP
5. ADDRESS (No., Streat, City, State, Country) 6. TYPE ANO LOCATION OF SERVICE (If known)

@ | SECTION XXI REFERENCES, ACQUAINTANCES, AND NEIGHBORS e
1. LIST FIVE CHARACTER REFERENCES, NOT RELATIVES, IN THE U.S., WHO KNOW YOU INTIMATELY

(Last-Firat-Middle) (No., Street, City and State) ae ({No., Street, City and State) .
Mr. .and Mrs. (Jose Esp{nog a)\ San Marcos, Texas (San Marcos,) Texas
. 6
Mr, (Thaxter Goodell) N\Washington, D.C, : Alexandria irginia
>— 1711 Massachutes Ave.|,)o%
Mr, (Alfred Beaty Dept. of Agriculture | Washington, D.C
Cpl, (Michael Hennessy Lima, Peru tMiraflores, Lima, Per

2. LIST FIVE PERSONS, IN THE U.S. WHO KNOW YOU SOCIALLY - NOT RELATIVES, SUPERVISORS OR EMPLOYERS

(Last-First-Middte) (No., Stgeet, City and State) (No., Street, City and State)
’s) Departme Hilitop House} o& |
ickland Jr washing 2 J pc Li d fash DG
i D ovat: 6 Ohio

fl73 Bartolome Herrera
ores img Per

“BUSINESS ADDRESS : RESIDENCE ADORESS i
(Laast-Firat-Middie) (No., Street, City and State) (No., Street, City and State)

Ga oo

14.90000

SECTION XXII CLUBS, SOCIETIES, AND OTHER ORGANIZATIONS

NOTE: List names and eddresses of all clubs, societies, professional societies, employee groups or organizations of any kind -
(Include membership in, or support of, any organization having headquarters or branch in a foreign country) to which you

* belong or have belonged.
(Number, Street, City, State, Country) [From | To
oo
(San Marcos) Texas sep 195h

G Ge High School, Sept.,.
o3s)J0 Texas _ 19

} y ex G

2? . .

NAME AND CHAPTER

i
rs)
ed

19

ee

=
f
<4

SECTION XXHI . RESIDENCES FOR THE PAST 15 YEARS
(Mamber, reat City State, Coun) [row [ed

#20

ALGAAS

Le 96

1 : '€: . 2 O| Ms 9
5 ;

USIS Building ra _& ith Floors, La Paz, Bolivia
‘eT Company, Headquarters Marine Gorps, Henderson

Hall, Washington 2 D.C, Sept.,1958 Nov. ,199
Cold Weather Training Battalion, Pickle Meadows, . Laue 198
Bridgeport, California ~ Jan 1953 Aug 9G
Marine Corps Base 9 Palms, California Dec. 195} Janes 14
Martne Corps Recruit Depot, San Diego California
Marine Corps Base cage Pendleton California De q

re)

S01 S. Guadalupe St., San Marcos, Texas
(Howard Payne Co11 Se Brownwood,) Texas
Sol Ss. Guadalue St., San Marcos, Texas | sone | sent...

. .

_ ener: a a OE

ee enamel

14-0000

tate
. x moe

-1 SECTION XXIV

ADDITIONAL INFORMATION

- .

1. DO YOU ADVOCATE OR HAVE YOU EVER ADVOCATED; OR ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF;
OR HAVE YOU EVER SUPPORTED OR BEEN ASSOCIATED WITH ANY POLITICAL PARTY, INDIVIDUAL OR ORGAN -
IZATION WHICH ADVOCATES OR TEACHES THE OVERTHROW OF THE GOVERNMENT OF THE UNITED STATES BY
FORCE, VIOLENCE OR OTHER UNCONSTITUTIONAL MEANS, OR SEEKS BY FORCE OR VIOLENCE TO OENY PERSONS
THEIR RIGHTS UNDER THE CONSTITUTION OF THE UNITED STATES?

2. IF YOU HAVE ANSWERED °YES® TO THE AGOVE QUESTION, EXPLAIN

[ fves | 4. IF SO, TO WHAT EXTENT? f
3. DO YOU USE OR HAVE YOU
EVER USED INTOXICANTS? X[xo |
. IF 50, TO ?
5. DO YOU USE OR HAVE You | [ves [& IF s WHAT EXTENT
EVER USED NARCOTICS? x[xo |

J. HAVE YOU EVER BEEN A MEMBER OF, OR SUPPORTED, OR HAD ANY CONNECTIONS WITH A FOREIGN INTELLIGENCE ORGAN-
IZATION OR ITS ACTIVITIES? Coy
Es

[xno IF ANSWER IS "YES®, GIVE COMPLETE DETAILS.

8. LIST BELOW THE NAMES OF GOVERNMENT DEPARTMENTS, AGENCIES OR OFFICES TO WHICH YOU HAVE APPLIED°?FOR EM-
PLOYMENT SINCE 1940

I served years in the United States Marine Corps. a

KNOWLEDGE, ANY OF THE ABOVE HAVE CONDUCTED AN INVESTIGATION OF YOU, INDICATE THE NAME OF THE
D THE APPROXIMATE DATE OF THE INVESTIGATION.

An investigation ( I do not know by whom) was conducted prior
to my departure for Bolivia where I was attached to the American
or ges. This investigation took place during August and September
of 1958.

NOTE SPECIAL| If your answor is "YES* to the following Questions 10, 11 er 12, provide the Information requested for each
INSTRUCTIONS | question on a seporate, signed sheet and attach the sheet to this form in a sealed envelope.

10. HAVE YOU, OR TO YOUR KNOWLEDGE HAS YOUR SPOUSE, EVER BEEN DETAINED, ARRESTED, INDICTED OR CON-
VICTED FOR ANY VIOLATION OF THE LAW OTHER THAN A MINOR TRAFFIC VIOLATION IN THE UNITED STATES OR

IF SO, STATE NAME OF COURT, CITY, STATE, COUNTRY, DATE, MATURE OF OFFENSE AND DISPOSITION OF CASE
IN ACCORDANCE WITH THE SPECIAL INSTRUCTION ABOVE.

11. HAVE YOU EVER BEEN ARRESTED, COURT-MARTIALED OR OTHERWISE PUNISHED UNDER MILITARY LAW OR REG-
ULATION? IF SO, DESCRIBE INCIDENT(S) AND PROVIDE DATE(S) OF OCCURRENCE ON SEPARATE SHEET IN AC~
CORDANCE WITH SPECIAL INSTRUCTIONS ABOVE.

RE ANY UNFAVORABLE INCIDENTS IN YOUR LIFE, NOT MENTIONED ABOVE, WHICH MAY BE OISCOVERED
QUENT INVESTIGATION, WHETHER YOU WERE DIRECTLY INVOLVED OR NOT, WHICH MIGHT REQUIRE EX-
PLANATION? IF SO, DESCRIBE INCIDENT(S) AND PROVIDE DATE(S) OF OCCURRENCE ON SEPARATE SHEET IN AC-
CORDANCE WITH SPECIAL INSTRUCTIONS ABOVE.

SECTION XXV PERSON TO BE NOTIFIED IN CASE OF EMERGENCY
1. NAME (Firat-Middle-Last) 2. RELATIONSHIP

Mrs. Daniel Flores Wife
3. HOME ADDRESS (No., Street, City, Zone, State, Country) 4. HOME PHONE VS
Washington 8, D.C 265-8322 0”

Ss ‘BUSINESS ADDRESS (N: , Zone, State, Comtry) - INDICATE NAME OF FIRM OR

EMPLOYER, IF FSS (Wo. Steet
oykin and De Francis »°5
1000 16th St., Suite 603} Washington 6, D.C.

7. IN CASE OF EMERGENCY, OTHER CLOSE RELATIVES (Spouse, Mother, Father) MAY ALSO BE NOTIFIED. 1F SUCH NOTIFICATION

IS NOT DESIRABLE, BECAUSE OF HEALTH OR OTHER REASONS, PLEASE SO STATE.

0,
In all cases wife: Relative, Mrs. Vicente Patién) 631 S. River St.}°%
lo (Seguin, Texas Telephone (Fp 9~1087 \ a5

ad

14.90000

. gal ag 9

SECTION XXVI CERTIFICATION

YOU ARE INFORMED THAT THE CORRECTNESS OF ANY STATEMENT MADE
: WILL BE INVESTIGATED. IN THIS APPLICATION

1 have read and understand the instructions. | Certify thet the foregoing answers ore true and correct to the best of m
knowledge and belief. {| agree that ony misstatement or omission os to material fact will constitute grounds for immediate
dismissal or rejection-of my application. { also understand that any false statement made herein may be punishable by
low (U.S. Code, Title 18, Section 1001). .

we, ana
x (Cit

Yl.
Lh fh Abt een A A :
3. sigMeEp at (City and State) 7
Washington, District of Columbia

NOTE: Use the following space for extra details. Reference each continued item by sectio v7 id item number to which it relates,
sign your name at the end of the added material. If additional space is required us# extra pages the same size as this
page and sign each such page. ‘

MARITAL STATUS: Item #), Section XII . o&

September 1, 1956 to October 6, 1956. Married to(Lt. Col. Joseph G,
Moran\in Portland, Oregon, by Circuit Court Judge. Used name of (Moran)
until November 1,, 1960, when changed to Flores. _ o6

FATHER-IN-IAW: Item #5, Section XVII
Short name for Raymond

GEOGRAPHIC AREA KNOWLEDGE AND FOREIGN TRAVEL: Item #1, Section VI
Argentina 2 July 1959 to 3 July 1959 Travel

Panama 10 November 1958 to 13 November 1958 Travel -

SEE ATTACHED SHEET FOR PERTINENT INFORMATION RELATIVE TO STEP-MOTHER.

Signed at Washington, D. C., this j “~day of September,

1961.

Daniel Flores

14-0000

3

Ip

ATTACHMENT TO FORM NO. lhl - PERSONAL HISTORY STATEMENT

Section XV - nia

Full name: (oneepeton R,) Flores

Living: Yes

Other Names She Hag Used: None to my knowledge

Current Address: Ol S. Guadalupe Street, San Marcos,\ Texas
Date of Birth: Detember 8, 191) O

Place of Birth: Mexico

Citizenship: Mexican

If Born Outside U.S. - Date of Entry: December 8, 1922
Place of Entry: Unknown

Former Citizenships: None

Occupation: Homemaker and Missionary

Present Employer: (Mexican Baptist Church, SanMarcos, Texas
Never served in Military or other Government service to my knowledge,

This paper is attached to and hereby made a part of Form No. bbb.

cs

